Mary Harney (Dublin Mid West, Independent)

First, I do not accept that everybody who is admitted to a hospital should be there. We know from the bed utilisation study that a large percentage of patients should not have been in hospital in the first place. As Professor Drumm said at the committee the other day, many people are admitted in order to get access to diagnostics. Not only is that an issue for the public health system, it is also an issue for insurers. I am engaging with private insurers to make sure we do not support bad practice, which is that we financially support inpatient activity when it is not necessary.

We know a large percentage of patients who enter from accident and emergency are admitted when senior decision makers may not be available to deal with their issue. I spoke to a consultant friend recently who told me that when he was working in accident and emergency one weekend, he was able to discharge a large number of patients who were down for admission and refer them to his clinic the following week. That is an issue. The new consultant contract, with clinical directors and the huge new powers we have given, including nurse prescribing, will lead to a more immediate response.

Second, I am not aware of any hospital in the world, and I have visited some of the best, where there are not trolleys in accident and emergency.

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